Systemic dz Flashcards

Question

GCA, temporal arteritis

Answer 1

> 55 yo - affects medium sized/large vessels - STAT ESR, STAT CBC differential (increase in platelets & WBC), STAT CRP, temporal biopsy jaw claudication, anorexia, neck pain, scalp tenderness, temporal HAs & fever - 50% may develop polymyalgia rheumatica (fatigue and morning stiffness of hips and shoulders) AION 2' GCA due to occlusion of spcas (may not be present (24-48 hrs after onset) - IMMEDIATELY tx with steroids and aspirin (81mg), send to ER for possible stroke

Answer 2

ESR: men: > age/2 women: > age+10/2 CRP: >2.45 mg/dL Elevated CBC platelets: > 400,000 cells/uL ** 90% will have elevated ESR >50. An elevated ESR and CRP is 97% specific for GCA **

Answer 3

- systemic vasculitis involving upper respiratory tract, lungs, kidneys - granulomatous scleroueveitis, retroorbital mass lesion w/ proptosis, episcleritis, conjunctivitis, scleritis, ciliary vessel vasculitis - peripheral sclerokeratitis that may lead to corneal ulceration

Answer 4

multisystem disorder causing inflammation and vascular changes of skin and internal organs - dry eye, shrinkage of skin and conj

Answer 5

- monosodium urate crystal in joints - mainly in MTP of big toe (aka podagra) - Band keratopathy (bowmans layer, calcium) - Men - red hot joints - tx w/ allopurinol = inhibits xanthin oxidase (enzyme for uric acid production)

Answer 6

most common of the primary immunodeficiency dz Iga is most prominent Immnoglobulin external excretions, including tear film - mucosal defense - asymptomatic, respiratory tract infections, keratinization of the cornea, weight loss, diarrhea

Answer 7

- type 4 hypersensitivity - delayed 24-72 hours - cosmetics: makeup, shampoo, soaps, hairspray, fingernail, polish, perfume, jewelry, poison ivy, cls solution - medications: amnioglycosides (tobragent 30), trifluridine (antiviral), cycloplegics (tropicamide, phenyl), glaucoma meds (timolol, alphagan, trusopt, preservatives (thimerosal, BAK) ocular signs of contact dermatitis: acute periorbital swelling conjunctival chemosis, redness, itching, and tearing

Answer 8

gram (+) infection with colored crusted lesions very common in children

Answer 9

2 types: - HSV1 = most common, above teh belt, most associated with ocular manifestations - obtain from primary infection as a child - virus hides in the trigeminal ganglion - reactivation can be triggered by stress, sun exposure, hormonal changes, fever, trauma, immuno-suppression - HSV2 = below the belt, sexually transmitted, herpetic keratitis in neonates Primary exposure = bleph w/ focal vesicular lesions on the eyelids and periorbital skin Recurrent infections = dendritic keratitis, marginal or geographic ulcers, neurotrophic keratopathy, interstitial keratitis, necrotizing stromal keratitis, disciform endotheliitis, acute anterior unilat nongranulomatous uveitis with trabeculitis, acute retinal necrosis

Answer 10

- initially presents as chickenpox - lays dormant in nerve roots - >50, consider medical eval if they are <40 to determine if they are immunocompromised - bleph w/ vesicles on eyelid, acute follicular conjunctivitis, episcleritis, pseudodendritic keratitis, acute anterior unilateral non-granulomatous uveitis with trabeculitis, acute retinal necrosis, optic neuritis, EOM palsies, proptosis Hutchinson's sign = vesicular rash on tip of the nose indicating V1 involvement which increases risk of other ocular involvement

Answer 11

- recurrent oral aphthous uclers - genital ulcers, eye lesions, skin lesions - asian and middle eastern young adults - acute recurrent hypopyon (classic for behcet's), iritis, ant uveitis, retinal vasculitis, vitritis, 2' cataracts, glc, and neo lesions

Answer 12

- common cancer in young women - depth invasion is the number one prognostic factor - risk factor = age, skin, color, fam hx, and repeated irritation and sun exposure - ABCDE = asymmetry, border irregularity, color differences, diameter, enlarging found on stratum basal superficial spreading melanoma is the most common variant of melanoma - rapid growth, classically found on non-exposed skin

Answer 13

- malignancy of the basal cell layer of the epidermis - early pearly - telangiectasia - progression to lead to rodent ulcer

Answer 14

- malignancy of the stratum spinosum - nonhealing ulcer that appears as an erythrematous plaque - can arise from precancerous lesion called actinic keratosis

Answer 15

- rare congenital vascular disorder characterized by a facial capillary malformation known as port wine stain - seizures, focal neurologic deficits, mental retardation - unilat glc (due to incr episceral venous pressure) - vascular malformation of conj, episclera, choroid and retina - iris heterochromia

Answer 16

- multisystem genetic dz that causes benign tumors to grow in the brain and other organs - hypopigmented macules (ash-leaf spots), shagreen patches (leather thick skin that is dimpled like an orange peel, usually found on the lower back or neck), angiofibroma, and a distinctive brown fibrous plaque on the forehead - retinal lesions such as astrocytic hamartomas or phakomas (grey/yellow lesion), these can calcify and be seen on a CT scan - punched out areas of chorioretinal depigmentation in midperiphery of retina - coloboma - angiofibroma of the eyelid -papilledema

Answer 17

abnormal dominant gene - 75% of children will have condition

Answer 18

2 abnormal recessive gene - 50% of children will have condition

Answer 19

defective recessive gene on the Xchromosome - half of sons will have condition - half of daughters will have condition

Answer 20

- common chromosomal disorder - extra 21st chromosome mental retardation, flat facial profile, prominent epicanthal folds, congenital cat, glc, strab, asimian crease on palms, congenital heart dz, early onset of alzheimer's - down syndrome pts are at increase risk for develpment of keratoconus (TDOME)

Answer 21

" calvin klein is a guy" - most common cause of primary hpogonadism - extra X chromsome (XXY) - testicular atrophy, long extermities, gynecomastia, female hair distribution, hypogonadism

Answer 22

Tina turner is a girl (XO) - absent x chromosome - keratoconus, strab, amblyopia, reduced accommodation, and convergence insufficiency - affects 1 in 3000 females and is characterized by short stature, dysgenesis, webbing of neck, coarctation of the aorta - most common cause of primary emnorrhea (no menstrual periods) - will affect binocular system = strabismus and amblyopia

Answer 23

occur equally in males and females - usually occur after puberty Ex. von hippel lindau dz, NF1 type 1 (von recklinghausen's dz), Marfan syndrome, Huntington's Chorea, Familial Adenomatous Polyposis (FAP)

Answer 24

- AD - manifested by a host of benign and malignant tumors - retinal angiomas that can hemorrhage if left untreated, leading to Rd, glc, and loss of vision

Answer 25

- tumor-forming nerve cells - cafe au lait spots, neurofibromas, lisch nodules on the iris - optic nerve glioma - congenital glc

Answer 26

- CT disorder characterized by skeletal anomalies (very tall w/ long extremities, subluxating joints, long finger and toes) - cardiovascular SE aortic incompetence, dissecting aneurysm, floppy mitral valves (cant play basketball) - subluxation of cyrstallin lens (sup temp), glaucoma, RD

Answer 27

- AD located on chromosome 4 - gradual onset and progression of chorea (involuntary muscle mvmts) and dementia - clinical onset 30-50yo with 15-20 year survival - abnormal eye mvmts will occur and include a delay in pursuits, voluntary saccades, and refixation

Answer 28

Deletion on chromosome 5 - results in hundreds of polyps on the colon post puberty - 100% of pts get colon cancer - Gardner syndrome is a variant of FAP characterized by multiple atypical CHRPES ( 4 or more, often tear drop shaped with a hypopigmented border on one end

Answer 29

usually seen in 1 generation - 25% of offspring from 2 carrier paretns are affected - dz often more severe compared to AD dz ex. sickle cell, PKU, tay sachs

Answer 30

- painful - RBC causing blockages within arteriole vessels; this ultimately results in organ failure - caused by a single base pair mutation in the beta globin gene where valine is substituted for glutamic acid - 1 in 400 aa are affected - sickle cells can occlude retinal arterioles leading to ischemia and subsequent retinal neo (proliferative retinopathy) = "sea fan retinopathy"

Answer 31

- caused by mutation in the enzyme phenylalanin hydroxylase - this is used in AA conversion of phenylalanine to tyrosine - if not treated, it will result in mental retardation - All newborns are tested for PKU - if pt is a positive carrier then diet low in phenylalanine is initiated - phenylalanine is found in milk products, aspartame, meat, chicken - occur in 1/10,000 people

Answer 32

- genetic disorder that most commonly affects eastern european Jews - progressive destruction of the nervous system - cherry red spot in retina - atrophy of ON

Answer 33

- Fabry's dz - Duchenne Muscular Dystrophy

Answer 34

- caused by abnormal lipid deposit in blood vessel walls - deficiency of enzyme alpha galactosidase A allows lipids to build up to harmful levels in the eyes, kidneys, ANS, and cardiovascular system - affects adolescent boys and is characterized by excruciating pains in extremities and abdomen - areas of telangiectasias on the umbilicus, groin, elbows, knees ocular findings: whorl shaped keratopathy

Answer 35

duchenne muscular dystrophy

Answer 36

- deletion within the gene encoding dystrophin - 1/30,000 male infants are afflicted w/ sx appearing by age 5 - muscle weakness that begins in the pelvic girdle and progresses superiorly (walk and get tired)

Answer 37

- caused by host of genetic defects giving rise to abnormal collagen synthesis - characterized by multiple fractures occurring iwht minimal trauma - ocular findings = blue sclera, keratoconus, megalocornea TDOME

Answer 38

Lebers hereditary optic neuropathy

Answer 39

- mitochondrial disorders - rare recessive disorder that results in bilateral asymmetric primary optic atrophy - 85% males - avg onset is late teens or early 20s - Early = optic disc hyperemia telangiectatic vessels late = progressive optic disc pallor with loss of central vision (BCVA 20/200 to CF) "my mother leber lost my eyes"

Answer 40

Iron deficiency - in adults results from GI blood loss (peptic ulcer dz, colon cancer) - occur with malabsorption or increased need with decreased intake (ex. childhood or pregnancy) - impairs cellular function causing brittle hair, nail spooning, and pica (eat dirt/ice) - tx with oral iron

Answer 41

decreased hemoglobin Iron deficiency Aplastic anemia

Answer 42

Pancytopenia is characterized by severe anemia, neutropenia, thrombocytopenia causes include - infection - radiation - drugs: chloramphenicol, acetazolamide, trimethoprim, methotrexate, pyrimethamine

Answer 43

drugs: chloramphenicol, acetazolamide/methazolamide, trimethoprim, methotrexate, pyrimethamine,

Answer 44

decreased amt of erythropoietin (EPO), a hormone that normally stimulates RBC production in the bone marrow

Answer 45

due to crescent or sickle-shaped cells occluding retinal vessels (think DRVOS)

Answer 46

inadequate intake or malabsorption of vitamin B12, often caused by pernicious anemia

Answer 47

autoantibodies directed against parietal cells of the stomach, causing decreased production of intrinsic factor B12

Answer 48

Dietary deficiency common in alcoholics - may be drug-induced (chemotherapy, methotrexate), or malabsorption sx - deficiency in pregnancy causing risk of neural tube defects (spina bifida)

Answer 49

parietal cells

Answer 50

- proliferation of malignant clone of plasma cells in the bone marrow - this results in extensive skeletal bone destruction, unexplained anemia, hypercalcemia, acute renal failure

Answer 51

malignant proliferation dz involving leukocytes - early cell growth and maturation are inhibited, causing malignant clones of these cells to accumulate - death results b/c of substantial loss of normal cells and poor organ function owing to the increase of malignant cells

Answer 52

Proliferation of malignant lymphoid cells in solid tissues (lymph nodes, spleen, GI tract) - localized initially but may subsequently spread 1. Hodgkin's lymphoma 2. Non-Hodgkin's lymphoma

Answer 53

2 peak age groups: 15-30 and then >50 - commonly presents w/ large lymph nodes, fever, night sweats, itching - Characterized by reed-sternberg cells Prognosis is good if its dx early - 50% of cases associated with EBV

Answer 54

Enlarged lymph nodes and GI tumors w/ abdominal pain - Heterogeneous group of malignancies with variable prognoses depending on the type - Bone marrow biopsy is performed to determine T or B cells

Answer 55

Hodgkin = - ages 15-30 and >50 - reedsternberg cells - associated with EBV - better prognosis Nonhodgkins = - occur at any age - T cell or B cell lymphoma - more common

Answer 56

- affects all ages but usually occurs in younger pts - predominate cell type is blast cells >30% of marrow are cells are blast (immature cells) - Acute Myeloblastic Leukemia (AML) = occur in infants/middle age or or older, excessive myeloblast, auer rods - Acute lymphoblastic Leukemia (ALL) = peak 2-10 yo, excessive lymphoblast, better prognosis

Answer 57

- occurs in infants and middle-aged or older - characterized by a normal WBC count with excessive myeloblasts - Auer Rods may be seen with leukemic cells in the blood

Answer 58

- peak age 2-10 years - Normal WBC with excessive lymphoblasts - better prognosis, 75% of children remain dz free >5 years with tx

Answer 59

leukemia and endocarditis

Answer 60

- usually affects older adults - predominant cells are mature cells of the bone marrow - pts often asymptomatic but may have anemia Chronic myelocytic Leukemia (CML) = 25-60yo onset, 3 year survival rate, 50-30K WBC count w/ increased grunolyctes in all states of maturation, philadelphia chromosome Chronic lymphocytic leukemia (CLL) = >50yo onset, 5 year survival rate, 20-200K WBC count w/ mature small lymphocyte, more common in male

Answer 61

- Age of onset 25-60 yo - poor prognosis, only 3 year survival rate - WBC count of 50-30K w/ increased granulocytes in all states of maturation - 90% cases have Philadelphia chromosome

Answer 62

- onset > 50 yo - Male:Female 2:1 - 20-200K WBC count with predominance of mature small lymphoctyes - 5-10 year survival rate

Answer 63

decr WBC due to bone marrow injury, bone marrow inactivation, drugs, or chemical supression

Answer 64

increase WBC count due to infections, illness, stress, pregnancy

Answer 65

increase number of neutrophils - results from stress, exercise, pain, fear, photologic infections (typically bacteria)

Answer 66

- Elevated platelet count - include inflammation, kidney dz, or spleen removal

Answer 67

Decr WBC and RBC and platelets

Answer 68

Decr platelets - caused by infection, liver failure, bone marrow disorders

Answer 69

- increased interstitial fluid that can be inflammatory (protein-rich) or non-inflammatory (protein-poor transudate) - recognized by swelling of legs due to subcutaneous edema or shortness of breath due to pulmonary edema - tx with diuretics and leg compression

Answer 70

Non-inflammatory - Increased organ pressure: CHF, liver cirrhosis, venous obstruction or compression - Reduced plasma osmotic pressure: protein-losing glomerulo-pathologies, malnutrition - Lymphatic obstruction: post-surgical or neoplastic - Sodium retention: excessive salt intake w/ renal insufficiency Inflammatory - Acute and chronic inflammation - Angiogenesis

Answer 71

caused by microaneurysms and dilation of capillary walls - pericytes, endothelial foot plates that surround vessels, are damaged, allowing leakage of blood and fluid = edema

Answer 72

leakage of blood due to vessel injury that may be uncontained or enclosed within a tissue - aka hematomas (within a tissue) petechiae = 1-2 mm heme on skin purpura = >3mm heme (trauma, local vascular inflammation, low platelet counts) ecchymoses = greater than 1-2cm (include subcutaneous hematomas or bruises) Hemothorax/Hemopericardium/Hemoperitoneum = large accumulation of blood in body cavities

Answer 73

- Blood clot in vein, occlusion of vessels after a relatively minor injury - can form anywhere in the circulatory system, may be arterial or venous and may be non-occlusive - most common location of thrombus formation is deep venous system in legs

Answer 74

cause of venous thromboembolism 1. alteration of blood flow (stasis) 2. Vascular endothelial injury 3. Alterations in constituents of blood through inherited or acquired hypercoagulable state (drugs, oral contraceptives, smoking)

Answer 75

oral contraceptives, smoking, vasculitits (temporal arterities), malignancies, immobilization/pregnancy

Answer 76

Factor V Leiden mutation, prothrombin gene mutation, protein C and S deficiency, and antithrombin III deficiency

Answer 77

occur in superificial or deep leg veins - deep leg veins (typically above the knee) are more likely to embolized heart or lungs

Answer 78

atherosclerosis, myocardial infarction - they usually travel (embolize) to brain, kidney, spleen

Answer 79

- associated with HTN and diabetes - conditions that most commonly result from thrombus formation

Answer 80

thrombus = clot remains where it was formed Embolus = clot that has dislodged from where it was formed

Answer 81

- any solid/liquid/gas mass carried by blood to a distance site from its point of origin **FAT BAT** Fat emboli = long bone fractures and liposuction Air emoblism = result from gas bubbles after chest wall injury or obstetric procedure Thrombus = number one cause of emboli *** Bacteria/Tumor = can cause tissue destruction and muscle pain Amniotic fluid emboli = can lead to DIC esp postpartum

Answer 82

- decr blood perfusion resulting form a reduction of either cardiac output or circulating blood volume CHAS Cardiogenic = heart not pumping blood Hypovolemic = heme and fluid loss from vomiting, diarrhea, burns, trauma Septic = overwhelming microbial infections or TSS gram + septicemia Anaphylactic = Histamine release

Answer 83

- abnormal dilation of vessels - true embolism = enclosed by complete arterial wall - most common aneurysms occur in abdominal aorta, iliac, and other large arteries -False aneurysms = can form with parts of arterial wall missing - death from rupture, pressure on adjacent structures, occlusion of proximal vessels, or emoblism from mural thrombosis - Pupil-involving CN 3 palsies - Associated with Marfans - abdominal aortic aneurysms are found in men older than 50 - risk of rupture increases with max diameter of aneurysms bulge

Answer 84

- slowly progressing dz of the arteries marked by elevated fibrosis and fatty intimal plaques - formed by fat deposits, smooth muscle and cell proliferation, and synthesis of the extracellular matrix - elastic arteries, descending thoracic artery, ICA, coronary arteries, abdominal aorta - SOB and chest pain - may begin in childhood and appears in middle age - tx = statin meds - arcus senilis

Answer 85

Endothelial cell injuries - monocyte and leukocytes circulating bloodstream to the injured vessel endothelium --> transform into macrophages --> attract lipids - accumulation of macrophages and adhesion of platelets in the injured area causes a massive plaque or clot to form = myocardial infarction

Answer 86

> 50 yo, family hx, HTN, smoking, hypercholesterolemia, and diabetes

Answer 87

Increased LDL, decr HDL, incr total cholesterol

Answer 88

Total cholesterol: <200 LDL: <130 HDL: >40 triglycerides: <150

Answer 89

atherosclerosis within the coronary arteries - asx, chest pain (angina), and dyspnea - if not treated, pt may suffer with MI - tx with 325 mg aspirin immediately

Answer 90

atherosclerosis of the carotid arteries - 25% of strokes are due to build up of plaque causing stenosis of the carotid arteries - present with sensory loss, dizziness, amaurosis fugax, or complete loss of vision in the ipsilateral eye, high pitched bruit over the artery

Answer 91

- most common primary dx in America - leads to increased heart attack, heart failure, stroke, kidney dz - 140/90

Answer 92

increase w/ age, fam hx, race, obesity, diabetes, smoking, excessive sodium intake - AA has the highest probability of HTN - Asians has the lowest risk

Answer 93

Characterized by narrowing of retinal arterioles - acute or advanced HTN = retinal vasculature may be injured enough to cause occlusion or leakage - changes seen on NFL = soft exudates and CWS, extravascular edema (hard exudates), intraretinal heme, retinal arterial macroaneurysms - HTN choroidopathy is often found in young pts with acute HTN = elschnig spots and siegrist streaks Severe HTN - optic neuropathy, flame heme, venous congestion, and macular exudates - papilledema found in stage 4 HTN retinopathy

Answer 94

- heart inability to fill with blood (diastolic heart failure) - inability to pump sufficient amts of blood through the body (systolic heart failure)

Answer 95

- blood backs up into lungs (pulmonary edema) - common cause is ischemic cardiomyopahty resulting from CAD (MI) - primary sx SOB (dyspnea on exercise)

Answer 96

- inability to pump blood into lungs causing blood to back up in the abdomen (ascites) and legs (lower extremity edema) - sx = edema, chest discomfort, SOB - most common cause is left-sided CHF; other causes = pulmonary HTN, COPD, right-sided MI

Answer 97

coronary heart dz, smoking, HTN, obesity, diabetes, valvular heart dz

Answer 98

BNP (Brain natriuretic peptide), cardiomegaly on chest x-ray, changes on echocardiogram Tx = b-blockers, ACE inhibitors, diuretics

Answer 99

- affects 5-15yo - results from untreated pharyngeal infection with group A beta hemolytic streptococci (strep pyogenes - this can alter shape of the heart valves (80% mitral valves is attacked), often requiring replacement later in life - s/s = fever, elevated ESR, red-hot joints, endocarditis

Answer 100

Bacteria may affect lining of the heart, esp the valves - risk factors = prosthetic heart valves, IV drug use, age - pt presents with fevers, sx from arterial emboli, or heart failure, depending on the severity of valvular damage - echocardiogram will show "vegetations" (mixture of bacteria and thrombus) on heart valves or abscess within the heart tissue

Answer 101

endocarditis or leukemia

Answer 102

- atypical rhythm - most are benign, irregular heartbeats, with the most common being premature ventricular complexes (PVCs) - increase w/ dehydration, stress, decr sleep, exercise, or pregnancy

Answer 103

- Temporary neurological deficits due to inadequate perfusion (always less than 24 hrs, usually less than 15 mins) - most likely caused by an embolism 2 types of TIA - carotid artery TIA - vertebrobasilar TIA

Answer 104

w/ contralateral hand/arm weakness or ensory loss and face and leg sx - pt can also have ipsilateral, amaurosis fugax, aphasia

Answer 105

diplopia, ataxia, vertigo, dysarthria, and either unilateral or bilateral visual loss

Answer 106

embolism found in the retina vasculature, often have TIAs and should be referred immediately

Answer 107

sudden onset of neurological deficits reflecting arteries involved and brain structures they supply Risk factors: HTN (#1), DM, hyperlipidemia, tobacco use, age, family hx Auscultation of subclavian and carotid arteries for a bruit can be a clue to early dx - CT scans used to determine size and location of stroke

Answer 108

- most commonly from a stroke in the occipital lobe that has affected either middle or posterior cerebral artery, NOT BOTH

Answer 109

usually caused by a tumor compressing both PCA and MCA never from a stroke

Answer 110

Ischemic stroke Hemorrhagic stroke

Answer 111

80% of strokes due to occlusion of artery leading to the brain - embolism of an atherosclerotic plaque is the most common cause - tx = stop smoking, meds for HTN, hyperlipidemia, diabetes

Answer 112

accumulation of blood within the brain due to bleeding from brain tissue, trauma, and/or vascular malfomrations - most common type of hemorrhagic stroke is subarachnoid heme

Answer 113

- sudden severe HAS, pupil involving CN 3 palsy, nuchal rigidity - 30% pt will have change in consciousness - head trauma, rupture of an intracranial aneurysm (most common cause) - occur btw PCA and ICA

Answer 114

meeting loop for the basilar artery, ICA, and ACA and PCA = small arteries bridging the basilar and internal carotid - forms beneath the brain and allows for a system of redundancy for the flow of blood to intracranial tissue

Answer 115

frontal lobe

Answer 116

frontal lobe, lateral surfaces of temporal and parietal lobe, occipital lobe last and largets branch of ICA

Answer 117

temporal and occipital lobe stroke involving this vessel can cause contralateral hemiplegia, hemianopsia, color blindness, verbal dyslexia, and opposite VF defect

Answer 118

Single events may be caused by fever, HAs, stress, illness, or neurological defects -s/s = cognitive dysfunction, nuchal rigidity, staring episodes, complete shaking of all ligaments - tx = antiepileptics (phenytoin, phenobarbital, carbamazepineine, valproic acid). Absence of seizures are treated with Klonopin

Answer 119

recurrent seizures

Answer 120

prolonged seizure

Answer 121

- abrupt transient loss of consciousness lasting a few seconds to a few minutes due to decreased blood flow to the brain - Prompt recovery to full consciousness follows syncopal episode - Causes = cardiac abnormalities (heart rhythm disturbances or valve disorders), vascular problems (postural hypotension or vasovagal episodes), or neurological disorders

Answer 122

Cluster HAs Tension HAs Migrain HAs Temporal Arteritis HAs Brain tumors

Answer 123

- men 30-50 yo - maybe orbital or temporal in location, usually unilateral - often occur in smokers and alcohol drinkers - often wake pts up at night or early morning - 1-2 attacks per day, each lasting less than 1 hr - Often present with red eyes and/or nasal stuffiness and can cause a transient or permanent ipsilateral Horner's syndrome

Answer 124

- occur in all ages, F - worse with stress and may precede a migraine HA - present like band-like distribution

Answer 125

- Women 20-30, rarely after 50yo - started by certain triggers - may present with or without auras, nausea, or photosensitivity - migraines last anywhere from 4-72 hours and aggravated by physical activity

Answer 126

- can cause HAs - all ages/sexes - associated with nausea, vomiting, visual changes, and steadily incr severity with time - Brain tumor-causing HAs tend to be worse in the morning - a child with a brain tumor is likely to have 1 or more other physical sx and 1 or more neurological deficits - less than 1% of pts with brain tumors have HAs as their only sx

Answer 127

- Inflammation of the meninges caused by various infectious agents such as viruses, bacterial, tb, fungi, or chemical agents - common and extremely hard to tx - preceded by upper respiratory tract infection - s/s = classic triad fever, HA, neck stiffness (meningism), nausea, vomiting, sweats, weakness, myalgias, papilledema, photophobia, 1/3 of pts will have seizures

Answer 128

seizures, dementia, focal lesions **brain tumors can be primary or metastatic*

Answer 129

Glioblastoma Multiforme - found in cerebral hemispheres and can cross the corpus callosum - prognosis is grave, with less than one year life expectancy

Answer 130

lung and breast

Answer 131

Meningioma - these arise from arachnoid cells and extend to the brain - can be malignant - middle aged women

Answer 132

Tumor of schwann cells - can cause gradual onset of painless, progressive, proptosis - localized to the 8th nerve (aka acoustic schwannoma) - Rare. most common in young to middle-aged adults

Answer 133

- functional (hormone secreting) or non-functional - Prolactin secreting tumor is the most common functional pituitary adenoma - can cause bitemporal hemianopsia or junctional scotoma VF defect

Answer 134

- recurrent inflammation of the CNS that results in demyelination - F 20-40yo - Caucasians living in northern latitudes and genetics - Systemic sx include weakness, numbness, tremor, lack of coordination, vertigo, bowel and bladder dysfunction, fatigue - sx may last weeks to months

Answer 135

- optic neuritis = most common presenting sx - pain on eye mvmt, APD, INO, and diplopia

Answer 136

dx requires 2 separate central CNS lesions (separated in space) on 2 or more occasions (separated in time) - these lesion must include involvement of white matter

Answer 137

sudden, non-progressive onset of monocular vision loss - Uhtoff's phenomenon

Answer 138

lesion in the MLF that results in loss of ipsilateral adduction and contralateral nystagmus

Answer 139

characterized by inflammation and demyelination of peripheral nerves and motor fibers of the ventral roots - classically present with symmetric ascending muscle weakness that begins in the distal lower extremities

Answer 140

Adies tonic pupil, diplopia (multiple CN palsies), facial diplegia - elevated protein and cerebrospinal fluid can cause papilledema - ptosis

Answer 141

- characterized by autoantibodies against ach receptors in the NMJ - affects all ages but more common in younger women and older men - associated with thymic tumor (thymoma), RA, lupus - s/s = respiratory weakness, and weakness of jaw muscles, ptosis, dipolopia, sx worse at the end of the day

Answer 142

- pt develops deposit plaques of protein called beta amyloid and disorganized masses of protein fibers within the brain cells (neurofibrillary tangles) - most common form of dementia, >65 yo - More prevalent in women, people with head injuries, down syndrome, prolonged exposure to chemicals, lower educational levels, and epilepsy - No cure but Aricept help slow progression

Answer 143

- have damaged area of brain tissue 2' to reduced cerebral blood flow - due to vessels having clots or fatty deposits (cerebral microinfarcts) - most prevalent who are at risk for strokes, esp with longstanding HBP and diabetes - it can occur together with alzheimer's dz

Answer 144

- deficiency of dopamine in the striatum due to degeneration of neurons in the substantia nigra - classic sx: tremor, rigidity, akinesia, and postural instability (TRAP). Slowness of mvmt. Slowness of mvmt is often the first sign, along with cogwheel rigidity and pill rolling tremor - Tx: levodopa, bromocriptine , Carbidopa, Sinemet

Answer 145

- after closed head trauma (fall/blow to head), blood collects between the skull and dura - middle meningeal artery is often affected due to laceration of temporal region of skull - injury has 3 phases: loss of consciousness, lucidity, another loss of consciousness

Answer 146

Venous blood collects btw dura and arachnoid space - pt may be asymptomatic depending on severity of causative trauma - Elderly = commonly seen w/ minor head injury esp on Coumadin - Sx vary, though altered mental state and HAs are common

Answer 147

- changes in pupillary size (blown pupil may signal impending uncal herniation) - Nausea or vomiting - Loss of consciousness

Answer 148

- lesion in the sympathetic pathway from the hypothalamus to the eye - classified as preganglionic central, preganglionic, postganglionic

Answer 149

Preganglionic central lesion: btw hypothalamus and ciliospinal center of Budge- Waller (C8-T2) - CVA, demyelinating dz, cluster HAs, tumor, **neck trauma** Postganglionic lesion: between ciliospinal center of budge Waller and superior cervical ganglion - **pancoast tumor**, thyroid mass, neck trauma, hx of thyroid or neck sx Postganglionic lesion: btw superior cervical ganglion and iris dilator muscle - carotid artery dissection, interal carotid aneurysm, cavernous sinus fistula, canvernous sinus syndrome, head trauma, cluster HAs)

Answer 150

ptosis, miosis, ipsilateral anhydrosis (no sweating or flushing on the affected side) - pt w/ carotid artery dissection may also present with neck and shoulder pain

Answer 151

preganglionic central or preganglionic lesion - while postganglionic lesion will only result in anhydrosis of the ipsilateral forehead, as most sweat fibers diverge away from the sympathetic fiber near the superior cervical ganglion

Answer 152

- less than 5% of cases - due to birth trauma causing brachial plexus injury, thoracic or cervical neuroblastomas (life-threatening tumors) - heterochromia

Answer 153

- Idiopathic condition (rule out CN 7 palsy) - sudden deficit of lower motor neuron in CN 7 causing facial muscle paralysis on the ENTIRE side of face - ectropion resulting in exposure keratopathy - Tx = patching/closing eyelid, oral steroids/antiviral, 71% will have complete recovery within one year without tx

Answer 154

- younger pts - most common sx polyuria, polydipsia, weight loss - 90% immune mediate and +HLA - beta cell destruction = lack of insulin - Tx = insulin injection, close monitoring of glucose and diet - Complications = Diabetic ketoacidosis, microangiopathy (retinopathy, nephropathy, neuropathy, cataracts and glc

Answer 155

- increased insulin resistance or abnormal B-cell secretions of insulin - most pts over age 40 - obesity - most pt asymptomatic at the time of dx - Tx = diet monitoring, exercise, oral glycemic agents, occasionally insulin

Answer 156

- reflects state of glycemia over the last 90-120 days - <7% - >126 or higher is abnormal

Answer 157

1. type 1= eye exam 5 years after dx 2. type 2 = needs eye exam ASAP

Answer 158

- extreme thirst and polyuria form lack of ADH or deficiency in renal response to ADH - Tx = increase fluid intake, intranasal desmopressin (ADH analog), indomethacin, or HCTZ for nephrogenic cause

Answer 159

Caused by abnormality that hinders the appropriate production of thyroid hormones - sx: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decr appetite, constipation, weakness, myxedema, dry cool skin, and coarse hair - Lab value: increase TSH, decr T3 and T4 - Hashimoto's Thyroiditis

Answer 160

- auto-immune mediated condition that attacks the thyroid gland - most common cause of hypothyroidism in **iodine-sufficient** areas of the world - common in ages 45-65 and F

Answer 161

- caused by Graves dz, autoimmune condition caused by TSH autoantibodies - constant thyroid stimulation of T3 and T4 hormones - middle age pts 4-5th decade, F - heart palpitations, weight loss, heat intolerance, hair loss - increased T4, decr TSH

Answer 162

- proptosis, UL retraction - less common = SLK, bilateral, inflammatory rx

Answer 163

- causes by hypercalcemia, oversecretion from parathyroid hormone - sx = bone pain, pathologic fractures, renal stones, constipation, mental changes, and fatigue - **band keratopathy** - tx = parathyroidectomy

Answer 164

- most common after thyroidectomy - tetany, muscle cramps, irritability, carpopedal spasms, convulsions, mental retardation - most prominent evidence is decr serum calcium - ocular findings = cataracts, uveitis, blurry vision

Answer 165

- ADD steroids (need steroids vs cushings dz has too much steroids in the body) - chronic adrenocortical deficiency that is the result of autoimmune atrophy of the adrenal glands - sx = weakness, fatigue, anorexia, weight loss, nausea, vomiting, diarrhea, ab pain, muscle and join pains, and amenorrhea - tx = replacement therapy with combo of glucocorticoids and mineralocorticoids

Answer 166

- effects of excessive corticosteroids on the body - the result of chronic, prescribed steroid meds - central obesity, moon face, buffalo hump - may have osteoporosis, poor wound healing, hyperglycemia, elevated serum cortisol levels

Answer 167

- rare condition caused by tumor secreting excessive amts of NE and epinephrine - can be located on one or both adrenal glands or anywhere along sympathetic nervous chain - any age but most common 40-60 yo - sx = elevated BP, papilledema, severe HA, perspiration, heart palpitations, anxiety, sense of impeding doom - tx = remove tumor - should be suspected in pts with HTN accompanied by HA (pain), palpitations, pallor, perspiration

Answer 168

Decr GFR Incr BUN and creatinine

Answer 169

kidneys failure to make urine and excrete nitrogenous waste - main causes are diabetes (most common) and HTN

Answer 170

Inflammation of the glomerulus of the kidney - there are 2 types: Nephritic syndrome: assoc w/ HTN, edema, active urine sediment with hematuria, blood casts and protein uria Nephrotic syndrome: associated with greater than 3.5 grams of protein in the urine. It is accompanied by hypoalbuminemia, hyperlipidemia, and edema

Answer 171

- renal infection caused by strep pyogenes - occurs 7-12 days after a respiratory infection or skin infection - most common in ages 5-15 years - sx = abrupt onset of hematuria, edema, HTN, and RBC casts in the urine

Answer 172

- very sick pts, pain when tapping kidneys - bacterial infection of the kidneys - sx = dysuria, frequency, urgency, fever, chills, flank pain, costovertebral angle tenderness, nausea/vomiting

Answer 173

- asymptomatic - if sx are present, triad = flank pain, hematuria, and abdominal renal mass - the first diagnostic test is an abdominal ultrasound

Answer 174

Chlamydia Gonorrhea HSV Syphilis

Answer 175

- Most common bacterial sexually transmitted dz in the US - cause cervicitis in women and urethritis and/or epididymitis in men - Serotypes A-C, D-K - Tx azithromycin or doxycycline

Answer 176

chlamydia - AIC - characterized by chronic follicles and papillae in the inf palpebral conj and fornices - minimal mucopurulent discharge - punctate keratitis, superior, pannus, peripheral SEIs and PAL

Answer 177

- trachoma conjunctivitis (chlamydia) - characterized by follicular and papillary conjunctivitis with mild superior pannus, arlt lines, herbert pits - Progressive scarring, superior tarsal conjunctiva may result in cicatricial entropion, with resulting trichiasis and corneal ulceration

Answer 178

- sexually transmitted dz caused by direct contact with Neisseria gonorrhoeae - signs and symptoms range from no sx, to vaginal discharge, pelvic pan, urethritis, and dysuria or urinary frequency - males are asymptomatic or burning upon urination - severe, hyperacute, purulent discharge - Tx: single dose ceftriaxone 250 mg IM plus Doxycycline 100 mg p.o. BID x 7 days (given together to cover for chlamydia)

Answer 179

- Type 1 and II (Both can be found in the eye) - Dx confirmed by multinucleated giant cells on a Wright-Giemsa stain - Type 1 = mucosal lesion on the lips - Type 2 = sexually transmitted dz and is found on the mucosa of male and female sex organs - tingling, irritation, itching - Tx = acyclovir or famciclovir (no cure but taken prophylactically)

Answer 180

- sexually transmitted dz caused by spirochete Treponema pallidum - 3 phases: primary, secondary, tertiary - primary = chancre (painless ulcer in genital region) - secondary = lesion can involve eye, kidney, mucous membranes, skin, or CNS, or liver - tertiary = leads to CNS and ophthalmic lesions including argyll Robertson pupil

Answer 181

- Interstitial keratitis, retinitis, retinal vasculitis - Salt and pepper fundus and flame-shaped retinal heme - Uveitis - CN and optic neuropathies - Acute multifocal chorioretinitis and vitritis

Answer 182

b/c of its variable presentation

Answer 183

+ FTA-ABS, + RPR and VDRL - positive 4-6 weeks after initial infection

Answer 184

(+)FTA-ABS, (-)RPR and VDRL - indicates pt had syphilis infection earlier in life and has now been tx, or has an earl syphilis infection (less than 6 weeks - (+)FTA-ABS if the pt has EVER had syphilis

Answer 185

FTA-ABS, RPR, VDRL - CDC recommends EIA or MFI as screening test (less false positives) - most tests screen for Syphilis IgG antibodies = if this is negative no other testing is needed, the pt does not have syphilis - If syphilis IgG is positive = RPR is performed

Answer 186

pt has untreated syphilis

Answer 187

FTA-ABS or TPPA is performed - if this is negative then it was likely a false positive test - if positive then pt has possible active syphilis and early syphilis infection (<6 weeks), or pt was previously tx for syphilis and no longer has active infection

Answer 188

Enlarged prostate - Tx w/ alpha 1 blocker, -prosin/Terazosin, sx - risk factor = male w/ fam hx, >50yo, - signs and sx include increased urinary frequency, urgency, nocturia, a weak stream, hesitancy and dribbling

Answer 189

- 2nd most common cause of cancer death in males - incidence increase w/ age - Risk facts = >50yo, fam hx, AA - elevated PSA (prostate specific antigen)

Answer 190

- s/s: amenorrhea, nausea, vomiting, breast tenderness, weight gain - lab test = incr human chorionic gonadotropin hormone (Beta HCG) levels - divided into 3 trimesters: 0-12 weeks, 13-26 weeks, and 27-40 weeks - common test during pregnancy: down syndrome (15-18 weeks), STD testing, ultrasounds (18-22 weeks), diabetic screening (26-28 weeks), Rhogam injection for Rh negative women (28 weeks), and group B strep test (36 weeks)

Answer 191

- spontaneous abortion (miscarriage) - occurs less than 20 weeks - Still birth - death to fetus after 20 weeks of pregnancy - Ectopic pregnancy = pregnancy within the fallopian tube or anywhere outside the uterus ( sx pelvic pain, fever, mass inside fallopian tube on ultrasound, increase HCG levels - Pre-eclampsia = triad of HBP (greather than 140mmHg), protein in urine, selling in the lower extremities. Best tx is to deliver the baby -- eclampsia occurs when the above sx are present and the pt has seizures -- both conditions can cause adverse effects in pregnancy, including still birth and maternal death, if not tx properly

Answer 192

oxytocin = milk ejection (posterior pituitary) prolactin = milk production (anterior pituitary) - benefits - mother/child bonding and transfer of immunoglobulins

Answer 193

- common but treatable in women - begins as cervical dysphasia and progresses over time to malignancy - risk factor = early sex and multiple sex partners, hx of HPV - abnormal pap smear - tx = sx, radical hysterectomy, chemo

Answer 194

2 main types: - Ductal carcinoma = starts in tubes (ducts) that move milk from breast to nipple - Lobular carcinoma = starts in parts of breast called lobules that produce milk - estrogen causes breast cancer tumor to grow - estrogen receptor-positive cancer or ER positive cancer - risk factors = age, fam hx, defects in BRCA1 and BRCA2 genes

Answer 195

breast> lung> colon

Answer 196

lung > breast > colon cancer

Answer 197

prostate > lung > colon cancer

Answer 198

lung > prostate > colon cancer

Answer 199

folic acid deficiency

Answer 200

defective closure of the posterior vertebral arches with intact meninges and spinal cord - spina bifida oculta = milder, no sx - Severe cases = lower body dysfunction, bowel/bladder/leg abnormalities - decreased learning capacity and enlarged ventricles are common - spina bifida can be sig reduced w/ folic acid supplement

Answer 201

most severe (100%) fatal neural tube defect disorder - orbital bones are normal but absence of brain and cranial bone tissue

Answer 202

"blue babies" - oxygen deficit

Answer 203

"blue kids" - less severe compared to blue babies - out of breath

Answer 204

fetal alcohol syndrome

Answer 205

shortened palpebral fissure, microphthalmos, strabismus, epicanthus, telecanthus, blepharoptosis, ON hypoplasia, retinal vessel tortuosity

Answer 206

- Not enough CO2 for the body - non-progressive varied infections, toxins, and congenital malformations in infants - s/s: mental slowness or retardation, impaired function of voluntary muscles, seizures, and speech and sensory defects, hyperactive reflexes are also common

Answer 207

- mother transfers this to fetus - microphthalmia, glc, cataracts - screened for in early pregnancy

Answer 208

- small malformed globe - w/o any other ocular defects = pure microphthalmos or nanophthalmos

Answer 209

mucous and membrane lesions on the fetus - if left untreated, baby can evelop interstitial keratitis and CNS disorders - screened early in pregnancy

Answer 210

- acquired by the fetus, can result in stillbirth - most will develop brain or eye problems including retinochoroiditis

Answer 211

rubella or galactosemia

Answer 212

Toxo rubella syphilis

Answer 213

mvmt of gastric juices into the esophagus due to gastroesophageal junction incompetence - cause heartburn - risk factors = alcohol, hiatal hernias, obesity, pregnancy, scleroderma, smoking

Answer 214

- caused by NSAID, heliobacter pylori, food intolerance, smoking - tx: H2 blockers, proton pump inhibitors, combination therapy (H2 blocker or PPI plus 2 antibiotics) for H pylori - Dx w/ endoscopy and barium swallow studies

Answer 215

Duodenal ulcer = sx include burning, hunger-like pain, primarily epigastric area, pain my occur or worsen on an empty stomach or worse in the middle of the night when acid secretion is the greatest Gastric ulcer = main sx is pain soon after eating

Answer 216

- Normal esophageal lining replaced by metaplastic columnar cells; occurs as a result of squamous changing to columnar cells - Dx via upper endoscopy w/ biopsy to confirm cell change - can lead to esophageal carcinoma (requires sx) - tx includes long-term proton pump inhibitors

Answer 217

2 main ones are - inflammatory bowel dz - crohns dz

Answer 218

think of a fat old cron skipping down a cobblestone road - infectious - occur at any portion of the GI tract, usually the ileum, small intestine, and colon - Rectal sparing - SKIP lesions - Transmural inflammation, cobbleston mucosa, creeping fat, bowel wall thickening, ulcers and fistulas - Strictures, fistulas, perianal dz, malabsorption and nutritial depletion - nongranulomatous uveitis

Answer 219

- autoimmune - colon, continuous lesion, rectal involvement - mucosal inflammation, friable pseudopolyps, crypt abscesses, and ulcers - severe stenosis, toxic megacolon, colorectal, carcinoma - non-granulomatous uveitis HIGHER PREVALENCE compared to crohns

Answer 220

- third leading cancer in both males and females - causes = low-fiber, high-fat diet, exposure to toxins - Risk factors = age, fam hx of. colon or breast cancer, - need colonoscopy - Tx = surgical removal, chemotherapy, radiation

Answer 221

- failure of copper to enter circulation in the form of ceruloplasmin leading to copper accumulation - affects brain, liver, cornea (Kayser-Fleischer Ring) - sunflower cataract, cirrhosis of liver, basal ganglia degeneration, and dementia

Answer 222

Penicillamine (Cuprimine) - chelating agent (binds to copper) - ocular SE = ocular myastenia (diplopia, ptosis), ocular pemphigoid, optic neuritis

Answer 223

- swollen, necrotic liver cells due to alcohol consumption - Mallory bodies (hyaline), fatty changes, and sclerosis around the central vein are also present, with an increase in AST and ALT liver enzymes

Answer 224

liver enzymes released into the blood in increased concentrations in cases of hepatitis

Answer 225

- Viral inflammatory conditions of the liver parenchyma that leads to necrosis includes type A-E - " bowels w/ vowels" - A = spread via fecal-oral route - B = spread via blood, IV drugs, sex - C = spreads like B, chronic hepatitis in 80% of hep C infections - D = carried only with hep B as a superinfection. increasing morbidity and morality - E = spread via fecal- oral route

Answer 226

A (2 shots) and B (3 shots)

Answer 227

A and E Vowels with the bowels

Answer 228

presence of fibrosis with creation of excessive extracellular matrix - normal blood flow through the liver is hindered and nutrient and metabolite exchange are thus reduced - most common causes are alcohol, viral hepatitis (drugs, toxins, CHF, biliary obstruction, autoimmune complexes) - complications = portal hypertension - GI heme and liver failure may result in death

Answer 229

- normal liver cells conjugate bilirubin and excrete it into bile (will eventually be excreted as urine) - Conjugated bilirubin is converted by bacteria to urobilinogen (can also be formed directly by heme metabolism) - jaundice occurs when pathway is either obstructed in the liver or bilirubin is hemolyzed in blood or cannot be excreted in urine - build-up of bilirubin in blood can cause yellowing of skin and conj (common in cirrhosis, hemolytic disorders, or obstructive gall bladder)

Answer 230

" angry gall bladder" - inflammation of the gallbladder 2' to obstructive cholesterol stones, sludge or infection - most common in females who are overweight or of childbearing age - pain in upper right quad, esp after meals - (+) Murphy's sign

Answer 231

- most common cause is alcohol abuse or gallstones (others = trauma, drugs, infection, hyperlipidemia, infection, tumor) - pain around umbilicus w/ possible radiation to the back - lab shows incr amylase and lipase

Answer 232

- the most common cause is chronic alcohol abuse - hx of recurrent acute pancreatitis - Periodic or continuous periumbilical pain radiates through the back - weight loss, steatorrhea (fatty stools), diabetes

Answer 233

- loss of conduction is the most common form of hearing loss due to cerumen impaction or trauma (others include sensory loss or neural deficits) - Sensory hearing = due to deterioration of cochlea - Neural loss = damage to CN 8 - Tests = Weber test and Rinne test to determine the culprit

Answer 234

- pain in ear from bacterial infection - Strep. pneumonia and H. influenza - Tx amoxicillin or other gram + agents - Very common in infants/children

Answer 235

- dz of the vestibular ear system causing dizziness and nystagmus - True vertigo = ALWAYS associated w/ nystagmus

Answer 236

Meniere's dz = vertigo, hearing loss, tinnitus Tx: cut tobacco, salt, antihistamines

Answer 237

- Inflammation of the paranasal sinuses due to viral/bacterial/fungal infection - may have anterior/posterior mucopurulent drainage, nasal obstruction, facial pain, pressure, fullness, decr sense of smell

Answer 238

Orbital cellulitis - most often ethmoid sinusitis

Answer 239

- runny nose, sneezing, conj hyperemia, water eyes - Tx = histamine receptor blockers, nasal spray, eye drops (patanol)

Answer 240

- enlarged cervical nodes, sore throat, fever - caused by viral or bacterial agents - Group A strep infections need to be tx with penicillin or gram + agents

Answer 241

- commonly located in the parotid or submandibular gland - swelling and pain of gland - S. aureus - Tx with antibiotics, IV nafcillin often used

Answer 242

- 80% involves parotid gland, 50% will be benign - asymptomatic mass in the gland and can extend deep into the facial nerve areas - MRI and CT scans used for dx - Tx = remove tumor

Answer 243

- acute and chronic inflammation 2' to arthritis, trauma, dislocations, developmental anomalies, and other factors - HAs, jaw pain, facial pain

Answer 244

- breathing disorder during sleep - inadequate muscle ton of the tongue and/or airway dilator muscle results in obstruction of the upper airway stopping the pt from breathing during sleep - s/s = disruptive snoring, daytime sleepiness, obesity (BMI >30), large neck circumference (>42 cm in men) - assoc. w/ HTN, fatal and nonfatal cardiovascular events (acute MI, atrial fibrillation), stroke, epilepsy, and diabetes

Answer 245

- FES - NTG - NAION

Answer 246

- obstruction of air flow to be trapped in the lungs - LEADING CAUSE is SMOKING - 2 categories 1. Emphysema (pink puffers) 2. Chronic Bronchitis (Blue bloaters)

Answer 247

- pink puffers - enlargement of air spaces and decr in recoiling b/c of destruction of alveolar walls - sx = shortness of breath (dyspnea), decr breath sounds, tachycardia

Answer 248

- Blue bloaters - productive cough for 3 consecutive months in 2 or more years due to hypertrophy or mucous secreting glands in the bronchioles - common sx include cyanosis of fingers and those and wheezing/crackling of lungs

Answer 249

B-blockers

Answer 250

- 2 primary components 1. Acute reversible bronchoconstriction (triggered by infection, allergens, stress) sx - coughing, wheezing, dyspnea, tachycardia - Tx w/ bronchodilators - abuterol, isoproterenol and metaproterenol 2. Chronic inflammation of airways - tx w/ inhaler or steroids

Answer 251

- restrictive lung, lungs cannot expand - caused by occupation inhalation of dust - AKA coal worker's pneumoconiosis, asbestosis, Silicosis, and Berylliosis - SOB, decr lung volume and compliance - chest x-ray will show diffuse infiltrates w/ ground glass appearance

Answer 252

- caused by airborne droplets of mycobacterium TB - fever, cough, **night sweats** - chest x-ray - always a (+) TB test if exposed

Answer 253

(+) test but negative chest x-ray

Answer 254

(+) test and (+) chest x-ray

Answer 255

"RIPE cheese" Rifampin Isoniazid (use in isolation in latent TB Pyrazinamide (NOT ON TEST) Ethambutol

Answer 256

Phlyctenules, Episcleritis, Scleritis, Keratitis, Bilateral chronic granulomatous uveitis, CME, Unilateral optic disc edema or papilledema, conjunctival granulomas

Answer 257

TB and sarcoid

Answer 258

- <15mm - <10mm (for healthcare workers) - >15mm (immunocompromised: HIV or bone marrow suppression) **>15mm is abnormal**

Answer 259

- TB test measures pts immune reactivity to M. tuberculosis antigens by measuring the amt of interferon-gamma produced by WBC in response to these antigens - CDC recommends using IGRA in place of TB skin test for TB testing during pregnancy, screening healthcare workers, contact investigations, pt undergoing eval for TB infection, pt who received BCG (vaccination or cancer therapy), pt who are unlikely to return for TB test readings

Answer 260

- TB test interpreted as follows based on Nil response, TB response, and Mitogen response (+) = most likely has TB (-) = not likely to have TB - does NOT differentiate btw active and latent TB infections, must include chest x-rays and sputum analysis to determine if pt has active or latent TB

Answer 261

TB skin test

Answer 262

- infection of lungs caused by bacteria or virus - most common cause is strep pneumonia (pneumococcus) - productive cough, SOB, fever - less common form is "walking pneumonia"

Answer 263

Mycoplasma pneumoniae

Answer 264

- Acute respiratory illness caused by influenza A or B - sx include fever, cough, rhinitis, HA, myalgias

Answer 265

Lung cancer

Answer 266

- most common cause of death in men and women - Adenocarcinoma most common lung cancer - Cigarette smoking leading cause, 2nd hand smoke and can also lead to lung cancer - maybe asymptomatic or may present with cough, hemoptysis, SOB, weight loss - bone pain from metastasis

Answer 267

Pancoast tumor - can cause horner's

Answer 268

- irritate normal cells which mutate and give rise to new cells - suppressor genes are often inactivated in pre-malignant cells - oncogenes facilitate and encourage cancer mutation and growth - can be benign or malignant - Melanocytic nevi are most common benign neoplasms

Answer 269

1. Behavior - benign, borderline, malignant 2. Degree of differentiation - well or poorly differentiated 3. Embryologic origins - epithelial (adenocarcinoma, squamous cell carcinoma), lymphoproliferative (leukemia, lymphoma), mesenchymal (sarcoma) 4. Gross appearance - well-circumscribed or infiltrative

Answer 270

- slow-growing and well-circumscribed - Ex. Adenomas, cystadenomas, papillomas, polyps

Answer 271

- often aggressive w/ invasion of adjacent tissues and have metastatic potential - metastatic = shifts from origin to another site in the body - carcinomas = arise from epithelial cells - sarcomas = arise from mesenchymal (CT) tissue

Answer 272

Rhabdomyosarcoma (CT cancer that causes bone destruction)

Answer 273

- abnormal growth of epithelial cells caused by a disruption in cell maturation - Low-grade dysplasia = earliest form of pre-cancerous lesion - High grade dysplasia = synonymous with carcinoma in situ (CIN) transformation into cancer is high but tx is still effective - Invasive carcinoma (cancer) = final step in this process - growth penetrates the epithelial basement membrane to invade tissue

Answer 274

- change from one mature cell type to another as an adaptive response from chronic irritation or a pathogen or carcinogen - tx aims to reverse cell damage - If left alone, dysplasia and cancer can result - Squamous cell carcinoma, the 2nd most common form of skin cancer, results from metaplasia

Answer 275

- protein-encoding genes that has the potential to cause cancer - Multiple oncogenes, such as the "Ras" oncogenes, have been found to play a role in specific cancers

Answer 276

- repress cell cyle and/or promote apoptosis - prevent DNA dmg and regulate cellular activities - Loss of tumor suppressor genes, such as BRCA gene in breast cancer, can lead to cancer

Answer 277

- a distorted view of body img and overwhelming fear of being fat - decr body weight (less than 85% of ideal body weight) - absence of 3 consecutive menstrual cycles - F>M

Answer 278

- binge eating 2 times a week for 3 months - compensate binge eating by vomiting, over-exercising, using laxatives

Answer 279

- protein malnutrition resulting in skin lesions, anemia, edema, liver malfunctions - very swollen belly on a malnourished appearing pt

Answer 280

- protein-calorie malnutrition resulting in tissue wasting - wasting and weight loss in affected individuals

Answer 281

- addiction to alcohol - withdrawal tremor, tachycardia, HTN, nausea, seizures, delirium tremens, and hallucinations - Alcoholics are more prone to gallstones, alcohol hepatitis, and cirrhosis of the liver - Alcoholic cirrhosis = long-term alcohol abuse causing micronodular cirrhosis; presenting sx include jaundice, hypoalbuminemia, coagulation factor deficiencies, portal HTN - Wernicke-Korsakoff syndrome = thiamine B1 deficiency - toxic optic neuropathy that leads to bilateral temporal optic nerve pallor

Answer 282

- caused by inappropriate transmitter involvement, metabolic abnormalities, or psychological factors. Strong genetic predisposition - sx: feeling of worthlessness, guilt, anxiety, fatigue, insomnia and withdrawal from social situations - tx = antidepressants, counseling, and electroconvulsive therapy

Answer 283

- sx of apprehension, worry, irritability, difficulty concentrating - Physical complaints include insomnia, tachycardia, HTN, nausea, diarrhea - Tx = benzodiazepines, antidepressant, counseling

Answer 284

- incr levels of dopamine in mesolimbic region - characterized by massive disruption of behavior, mood, thinking for at least 6 months - Tx antipsychotics Positive = delusions, thought disorders, inappropriate affect, incr motor fxn Negative = lack of speech and though, loss of emotional response, no effect, social isolation

Answer 285

- characterized by episodes of severe depression alternating w/ periods of mania - tx same with severe depression and may include hospitalization - Manic episodes characterized by elevated mood, decr need for sleep, flighty thought, dec reasoning skills, incr activity, aggressive behavior - Mania is often followed by periods of severe depression

Answer 286

- common cause of death in US - serious depression, alcohol and substance abuse, stressful life events - highest risk are middle-aged white and elderly men, though women and teens report more suicide attempts - Tx = hospitalizations, depression meds, counseling

Systemic dz Flashcards

(316 cards)